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Endplate changes after lumbar discectomy with and without implantation of an annular closure device

  • Original Article - Spine
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Abstract

Background

The implantation of a bone-anchored annular closure device (ACD) might be associated with the developed new endplate changes (EPC) after surgery.

Methods

A post hoc analysis has been done in patients from a prospective randomized multicenter study. All patients underwent limited lumbar discectomy with intraoperative randomization into the groups limited lumbar discectomy alone or additional ACD implantation. Low-dose lumbar computed tomography (CT) and clinical investigations were performed preoperatively and 12 months after the operation.

Results

A total of 554 patients were randomized. After exclusion of dropouts, the per-protocol population included 493 patients (251 in the control group and 242 in the ACD group); the follow-up rate was ≥ 90%. The number of patients showing EPC at baseline was similar in both groups. The number of patients showing EPC and the total EPC lesion area significantly increased in both groups over time, but significantly increased more in the EPC group for the superior and inferior endplate (all P < 0.0001). There was no association of pre-existing number and size of EPC with sex, age, or smoking habits. Correlation of clinical variables showed no relation with number, size, and increase of EPC area after surgery.

Conclusions

Patients with primary lumbar disc herniation show EPC in the corresponding segments. There is a significant increase of lesion number and size within 12 months after discectomy. This increase is significantly more pronounced in the ACD group. Presence and growth of EPC is not correlated with low-back pain or ODI.

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Funding

Intrinsic Therapeutics, Inc. provided financial support in the form of analysis of all images at an independent institution (Intrinsic Imaging LLC, Bolton, Massachusetts, USA). The sponsor had no role in analysis and interpretation of the data.

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Authors and Affiliations

  1. Department of Neurosurgery, Knappschafts-Krankenhaus Bochum, Ruhr-University Bochum, In der Schornau 23-25, 44892, Bochum, Germany

    Martin Barth

  2. Department of Medical Statistics, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany

    Christel Weiß

  3. Department of Neurosurgery, OLVG, Academic Medical Center, Amsterdam, Netherlands

    Gerrit J. Bouma

  4. Department of Neurosurgery, Heinrich Heine University, Duesseldorf, Germany

    Richard Bostelmann

  5. Department of Neurosurgery, DONAUISAR Klinikum, Deggendorf, Germany

    Adisa Kursumovic

  6. Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland

    Javier Fandino

  7. Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria

    Claudius Thomé

Authors
  1. Martin Barth
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  2. Christel Weiß
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  3. Gerrit J. Bouma
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  4. Richard Bostelmann
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  5. Adisa Kursumovic
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  6. Javier Fandino
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  7. Claudius Thomé
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Corresponding author

Correspondence to Martin Barth.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the corresponding institutional research committees (multicenter study) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Barth, M., Weiß, C., Bouma, G.J. et al. Endplate changes after lumbar discectomy with and without implantation of an annular closure device. Acta Neurochir 160, 855–862 (2018). https://doi.org/10.1007/s00701-017-3463-y

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  • DOI: https://doi.org/10.1007/s00701-017-3463-y

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